My husband and I were having a debate about health care last night, when we should have been having steamy, dripping-wet sex...and here's the gist of what we concluded:

We don't quite understand why the U.S., as a nation, cannot afford to provide health care to all of our citizens. In one way or another, health care IS being provided to most of our citizens, by means of employers in most cases, but also through emergency rooms, indigent care, etc. It's really not a matter of the total cost, it's a matter of who pays what.

As things stand, most people receive health care coverage through their employers, and pay relatively little of the cost themselves (although that's been changing steadily). But obligating employers to pay for health coverage makes it difficult for them to compete globally, since many of their competitors' employees are covered by single payer systems where the population as a whole bears the cost through taxation. That's one of the reasons GM has difficulty competing in a global market. So you would think it would make sense for GM and other large employers to support a system that takes the burden of health care off their hands. Ditto for small employers, who have difficulty even obtaining group insurance.

As for emergency room care for poor people, this is a very expensive, very inefficient, very reactive approach to indigent health care. If they get sick enough, they go to the ER. If they're not that sick, they suffer through it. But they get no preventive care, no health maintenance, no education. The long-term costs of that probably exceed what it would take to provide them with basic free health care.

It seems to me that if you added up all the money that people (and employers) are now paying for health insurance and direct medical expenses, and you were able to capture that and apply it toward a universal health care system, it wouldn't cost any more than we're currently paying. In fact, given the overhead involved in processing/denying claims, paying attorneys' fees, etc., etc., you could probably SAVE a great deal of money.

So why do we view universal health care as something we can't afford? It's just a matter of rearranging who pays what.

Your thoughts.

 

My thoughts??

We tend to over simplify or over complicate issues, depending on our position on the subject.

First "most" people who are insured by their employers plan, ultimately pay for it. The cost of employing someone is the sum total of all factors, salary, employer taxes, fringe benefits, vacation, etc. When the cost of employing people exceeds what the productivity allows, something has to give. Usually a reduction in benefits (i.e.:higher employee insurance cost) or an adjustment in staff to increase productivity to cost ratios. So those who do not have employer plans generally are able to join groups of similarly employed peoples.

Several years ago, 1986 to be precise, we were experiencing significant rate increases for our employee health plan, we had 350+ people on the payroll. Since our policy was to split the cost with the employee, we went to them with an alternative plan. We would continue to pay our portion, but in the way of an increase in salary. Then they would be able to participate in one of several plans that we had negotiated, they could buy the plan best suited to their needs. i.e.: An employee who was unmarried could opt out of a maternity plan.

In a few months we found that the bulk of the hourly employees were uninsured, they took the raise in salary and spent it elsewhere. The salaried employees had the opposite reaction, most had a good insurance plan in place.

My point is that often we find that many people, if given the choice, will err on the side of short term thinking. These are the same folks who do not take advantage of programs that are currently offered by federal, state and local governments. Prenatal screening, minor child innoculations, free of inexpensive flu shots, low cost clinics, etc.

They wait until they have aserious problem to seek medical care. This overburdens the emergency rooms and indigent healthcare facilities. Most major cities have healthcare programs in place for the homeless that are rarely used.

While I am not a proponent for federal programs of this ilk, I am more in favor of a universal plan, than not. My only reservation centers on the ability to get private care, if one wishes, I am afraid that we will dumb down the healthcare system just as we have done with public education.

 

It's considered socialized medicine and everybody knows socialism is "evil" eh?

The Canadian system was great, but it's being gutted by physicians and other private interests. The docs should be on salary not paid "fee for service", cause they just suck it dry. We have 8 to 10 hour waits in the ER now. Oh, and it ain't free, we pay combined 15% goods and services tax on everything!

 

This is a classic example of the problem. What isn't said is that the Canadian system is losing doctors faster than they can be replaced, the Indian medical student has a better shot back home or in the US than in Canada.

SO there ain't a free lunch. Hmmmmmmm, how would we (USA) do it differently?

 

UHC

Universal Health Care is essential. There should be a single payer system. There should not be a for profit provider. It should probably not be too easy for people to use, but it should be accessible when needed, and the Medical profession should be required to participate as a condition of theirlicense to practice. Private healthcare should be available for those who have the money and the conceit to pay for it.Cosmetic surgery should be included only for sever cases (i.e, cleft palate, burn victims, weight reduction in severely obese.. Hair restoration, tummy tucks, breast enlargement, etc, should not be included. ) There should probably be an independant czar, a dollar a year man, to oversee it, along with congressioal oversight. It should not be a political football.
RICO:rose:

 

We have a hell of a lot of Indian doctors, as well as from all kinds of other places. as does the US. I just wish they would be required to get better language skills when they get licensed. Could be English, French (for Quebec) or Spanish. My wife does Medical transcription and some of what she hears is appalling, She has to make sense out of it because it becomes the patients medical record, and the next doctor has to know WTF is going on

 

If you give people the option to participate or not participate, you'll have a hefty percentage of non-participants, mostly younger people who figure nothing's going to happen to them, or wealthier people who figure they'll pay as they go when something DOES happen. So I don't think you can let people opt out and have it work.

And I think you're right when you say that people end up paying, one way or another, for the cost of the fringe benefit they receive from their employer.

But that still argues for a universal health care system NOT delivered on an employer-by-employer basis. The trick is, how do you capture what employers and individuals are now paying, and how do you cut out all the middle men (e.g. the insurers, the lawyers, the paper-pushers), so that you can reduce the overall cost of health-care delivery?

And from a political standpoint, how do you persuade those who HAVE decent health insurance through their employer that they'd be better off with a different system?

 

I absolutely agree..

 

Many of the ideas for a universal plan keep insurance companies as the vehicle to deliver the payments to the healthcare provider. A large number (i don't know what it really is) of Medicare recipients chose a insurance company to manage their healthcare. A very large one here is HealthSpring, Blue Cross is another large one.

It has always struck me as odd that the government would allow them to do this, but it seems to work very well. Yet so many think that the gov't could do it better.

With the size of the healthcare system, the size of the insurance companies and the enormous cost of the whole current system, I would think that the congress would be hard pressed to make major changes.

 

I would disagree that the system works well -- it works well for those who can afford it. But the insurance-based system has too much of an automatic predeliction for denying treatment (doctors are actually rewarded for NOT recommending treatment, and for NOT referring people to specialists), and the overhead cost is too high. Whether government can do it more efficiently is open to debate, but there are examples out there (Canada, Europe) that suggest that costs can be reduced. Problems such as the one oldiegoody identified would have to be addressed, of course. How does one guarantee that there are an adequate number of physicians willing to work under such a system? But I think there are answers to these issues.

 

Let's take all of our wages and winnings and rents and dividends and put all of this hard earned money into a giant $lush fund. Then we can distribute it equally among all citizens, non citizens, honest and dishonest, lazy and downtrodden, criminals and just the insane. Everyone has needs, I know. While in principle it sounds like a great idea Kimiko, it will never fly in our society. As much as I want security blankets 2, you need to do for yourself. No handouts pleaz Dkr

 

There are. I haven't got time or energy right now, but check out the systems in Scandinavia, France, Belgium, Switzerland and many other western European countries, you will find answers. One of the best in the world is in Cuba. It's rated near the top. The US is like 35th or something.
It can be done if medicine isn't viewed as a business only for profit.

 

I was talking about gov't funded healthcare (Medicare) being administered by private health insurance companies, where does the "if they can afford it" come from??

 

Times like this, I think that maybe the UK got something at least right, even though it's certainly not perfect.

 

I believe the other question is who would manage the value involved in such a system. I get your zero-sum-game idea about the fact that we eventually "pay" for universal health-care anyways . . . and I happen to agree with it. When a company decides to provide health care to their employees, they add that cost into the price of their product and the average consumer supplies the funds with every purchase.

If we did go to a universal health care system, I would want the federal government to be as little involved in the managing of the program as possible. :-| They've wrecked the budget so completely I can't imagine there being a sliver of trust remaining.

I've often thought that a voucher system might work - wherein every citizen is given X credits of health care value and they can choose to use it as they see fit . . . alongside that a menu of costs for providers and services available. You want to spend your credits on acupuncture, go right ahead. You want to save 'em up and hope they cover the cost of your iron lung - be my guest. I'd expect there to be efficient and effective providers rewarded with business while the mediocre faded away.

Of course I'm being a bit pollyanna-ish that folks would suddenly start to see how spending a little on preventative care is such a smart long-term investment as to be incalculable The last issue is the problem of inequality - some folks (however selfish this may sound) may demand a refund for being healthy and crab about the sick folks taking up their "share" of the value in the system. People are people, after all.

 

I have seen few examples of socialized medicine in Germany. Perhaps some of our German members can talk about German socialized healthcare better than I can. It's not very impressive. Example, my grandmother had a problem breathing on a thursday and the doctor told her that the earliest he could see her was the following tuesday. She died on saturday. No real urgency, just a "get in line" attitude. I also have seen the hospital, they look pretty basic and "no frills" to me. From that point of view, I am not impressed by socialized healthcare.

However, on the other hand, I can remember being layed of as the major breadwinner and insurance provider in my family. When I lost my job, I had to use all of of my unemployment check to cover the cost of COBRA insurance. So, I started looking for alternate medical insurance. No one would accept me because they thougt I was a health risk! It didn't make sense because I was pretty healthy. At the time, unemployment was high and there were allot of people without health coverage. When I did find a job with health coverage, I still had to pay allot in spite of the insurance because I had someone end up in the intensive care unit for three years in a row. People without coverage get their bills paid by the state while I am struggling because I have a job with insurance. I'm glad I had the insurance, but, the coverage was only 95%. I had a few bill that were on the order of $100K of which I had to pay $5K for. This is a strain on your finance. So, I am not impressed by the current state of health care either.

What we need is a different system than we currently have. What that should be, who knows? Is Obama's plan a good one? Time will tell.

 

You are so disgustingly ignorant it literally sickens me but not totally worthless because you can always be used as a bad example.

Which is what this thinking really is and speaks directly to what Kimiko originally posted. It is undeniable that our nation (the one you claim to love so much) is facing a health care crisis and the system is staggering towards collapse. Something has to be done so the question is what, because the pathway and thinking you express here has obviously failed.

So here's what I see is the problem. Its not health care. Its actually insurance. Health insurance is actually the cause of our health care system's illnesses not the cure. And so the answer is to eliminate health insurance all together and pay for health care through taxes and provide birth to death universal health care.

But when it comes to thinking about this and discussing it we labor under two different fallacies. One is that we don't have a very costly and ineffective universal health care system now and the other one is that government financed (not run) health care systems don't work.

Kimiko hit the nail right on the head but let me put it in more simple terms. We as a nation do not allow people to die in the streets from treatable illnesses and diseases. We at least to our minor credit do provide health care for everyone. But the problem is as Kimiko pointed out they have to be close to dying first. This then has both direct and indirect ramifications. The direct ramification as Kimiko pointed out is by the time poor (and even uninsured middle class people) actually go to a doctor, usually in an emergency room the illness is so serious the costs of treating it skyrocket. The indrect ramification is that since these people get treated but can't pay the costs this is the reason a bandaid in a hospital may cost $5 or more which effects everyone with or without insurance.

As to the second fallacy it always stuns and gripes me no end that whenever this discussion comes up the first examples are problems in Canada and a few other places. How about the European Union where all of those countries have some form of universal health care and yet have a much higer standard of care then we do in the US? Why aren't those ever given as examples. The reason is simple. Both their system and actual health care is better than ours and for reasons I cannot understand it is more important for many of us to cling to the stupid think displayed by Deidre then it is to actually solve the problem and make us a stronger, healthier better nation.

 

Thank You Stumbler, you're ignorant oh so mature response speaks volumes for a 50 some year old. Thank you for being you. Dkr... :excited: you sicken me with your twisted vision and opinion. Do you and Kimiko want to debate me? You will always lose.

 

So well said.
Don't strain yourself there deidre, and if age is your pivot point here, yours is showing.


You must be following the rules of trolling.

Here's rule # (adapted to apply here)
Always Detract When Commenting

If you happen to find an intelligent discussion on sites such as Digg or Reddit, it is your duty to destroy it. Post inappropriate images of women, make stupid jokes aout the people in the thread, and if you feel the need to write stupid commentary about how stupid your fellow posters are, be sure never to back up your claims with facts and avoid using spell-checker at all costs. You will find it hard not to giggle when you see the way people react to comments like "you sicken me with your twisted vision and opinion. Do you and Kimiko want to debate me? You will always lose."

 

Hey, the posts speak for themselves, yours 2.